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Brennand EA, Scime NV, Huang B, McDonagh Hull P. Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women. Acta Obstet Gynecol Scand 2024. [PMID: 39223035 DOI: 10.1111/aogs.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/22/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women. MATERIAL AND METHODS We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000-2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking. RESULTS Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55-1.82; college degree: AOR 1.58, 95% CI 1.45-1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (e.g., at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49-1.75; college degree AHR 1.53, 95% CI 1.40-1.67). CONCLUSIONS Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.
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Affiliation(s)
- Erin A Brennand
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Beili Huang
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline McDonagh Hull
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Asl FM, Maserat E, Vaezi M, Mohammadzadeh Z. Designing a core data set for benign hysterectomy registration system and its implementation in a referral teaching hospital in Northwest Iran. BMC Pregnancy Childbirth 2024; 24:460. [PMID: 38961444 PMCID: PMC11223272 DOI: 10.1186/s12884-024-06656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND AND AIMS Although minimally invasive hysterectomy offers advantages, abdominal hysterectomy remains the predominant surgical method. Creating a standardized dataset and establishing a hysterectomy registry system present opportunities for early interventions in reducing volume and selecting benign hysterectomy methods. This research aims to develop a dataset for designing benign hysterectomy registration system. METHODS Between April and September 2020, a qualitative study was carried out to create a data set for enrolling patients who were candidate for hysterectomy. At this stage, the research team conducted an information needs assessment, relevant data element identification, registry software development, and field testing; Subsequently, a web-based application was designed. In June 2023the registry software was evaluated using data extracted from medical records of patients admitted at Al-Zahra Hospital in Tabriz, Iran. RESULTS During two months, 40 patients with benign hysterectomy were successfully registered. The final dataset for the hysterectomy patient registry comprise 11 main groups, 27 subclasses, and a total of 91 Data elements. Mandatory data and essential reports were defined. Furthermore, a web-based registry system designed and evaluated based on data set and various scenarios. CONCLUSION Creating a hysterectomy registration system is the initial stride toward identifying and registering hysterectomy candidate patients. this system capture information about the procedure techniques, and associated complications. In Iran, this registry can serve as a valuable resource for assessing the quality of care delivered and the distribution of clinical measures.
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Affiliation(s)
- Fatemeh Moghadami Asl
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 5165665811, Iran
| | - Elham Maserat
- Department of Medical Informatics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Vaezi
- Associate professor of Gynecology, Oncology, Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Clinical Research Institute, Alzahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Mohammadzadeh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 5165665811, Iran.
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Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A. Day surgery for endometriosis in Canada: A retrospective cohort of trend and regional variation in types of surgeries and their complications. Aust N Z J Obstet Gynaecol 2023; 63:760-767. [PMID: 37264738 DOI: 10.1111/ajo.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND A significant proportion of patients with endometriosis require surgery for management of the disease. AIMS We aimed to assess the trend and regional variation in day surgeries for endometriosis across Canada and to identify perioperative complications associated with types of surgeries and their temporal trend and regional variation. MATERIALS AND METHODS We conducted a retrospective cohort study of women undergoing day surgeries for endometriosis between 2015 and 2019 using Canadian administrative data from the National Ambulatory Care Reporting System, which includes data from four provinces (Ontario (ON), Alberta (AB), Nova Scotia (NS) and Prince Edward Island (PEI)). Multivariate logistic regression models were used to compare perioperative complication rates, while adjusting for site(s) of endometriosis lesion, age, type of surgical intervention, and comorbidities. RESULTS During the study period, the rate of day surgeries for endometriosis remained nearly constant at 80-90 cases per 100 000 women of reproductive age (P = 0.12). The rate of day surgeries was significantly different between provinces (AB = 94, NS = 93 vs ON = 85 per 100 000 women of reproductive age: P < 0.02). The odds of complications decreased with time (2019 vs 2015; adjusted odds ratio (aOR): 0.84; 95% CI: 0.73-0.98). There was a significant regional variation in the frequency of perioperative complications (PEI vs ON aOR: 4.13, 95% CI: 2.58-6.62; and NS vs ON aOR: 1.47, 95% CI: 1.11-1.95). CONCLUSION The rates of day surgery for endometriosis remained stable and the risks of perioperative complications decreased during the five-year study period. However, there were significant regional variations in the risk of perioperative complications.
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Affiliation(s)
- Foruzan Bahrami
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Sarah Maheux-Lacroix
- Department of Obstetrics and Gynaecology, Université Laval, and Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Amélie Boutin
- Department of Pediatrics, Université Laval, and Reproduction, Mother and Youth Health & Population Health and Optimal Health Practices Units, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
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Scime NV, Brown HK, Shea AK, Brennand EA. Association of infertility with type and timing of menopause: a prospective cohort study. Hum Reprod 2023; 38:1843-1852. [PMID: 37451681 PMCID: PMC10477942 DOI: 10.1093/humrep/dead143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
STUDY QUESTION What is the association between past infertility and the type and timing of menopause in midlife women? SUMMARY ANSWER Women with a history of infertility were more likely to experience surgical menopause overall and had elevated risk of earlier surgical menopause until age 43 years but experienced no differences in the timing of natural menopause. WHAT IS KNOWN ALREADY Infertility is experienced by 12-25% of women and is thought to reveal a propensity for poor health outcomes, such as chronic illness, later in life. However, little is known about whether infertility is linked with characteristics of the menopausal transition as women age, despite possible shared underlying pathways involving ovarian function and gynecologic disease. STUDY DESIGN, SIZE, DURATION Secondary analysis of a prospective cohort study of 13 243 midlife females recruited in Phase 1 of the Alberta's Tomorrow Project (Alberta, Canada) and followed approximately every 4 years (2000-2022). PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected through standardized self-report questionnaires. History of infertility, defined as ever trying to become pregnant for more than 1 year without conceiving, was measured at baseline. Menopause characteristics were measured at each study follow-up. Menopause type was defined as premenopause, natural menopause, surgical menopause (bilateral oophorectomy), or indeterminate menopause (premenopausal hysterectomy with ovarian conservation). Timing of natural menopause was defined as the age at 1 full year after the final menstrual period, and timing of surgical and indeterminate menopause was defined as the age at the time of surgery. We used flexible parametric survival analysis for the outcome of menopause timing with age as the underlying time scale and multinomial logistic regression for the outcome of menopause type. Multivariable models controlled for race/ethnicity, education, parity, previous pregnancy loss, and smoking. Sensitivity analyses additionally accounted for birth history, menopausal hormone therapy, body mass index, chronic medical conditions, and age at baseline. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 18.2% of women reported a history of infertility. Past infertility was associated with earlier timing of surgical menopause exclusively before age 43 years (age 35: adjusted hazard ratio 3.13, 95% CI 1.95-5.02; age 40: adjusted hazard ratio 1.83, 95% CI 1.40-2.40; age 45: adjusted hazard ratio 1.13, 95% CI 0.87-1.46) as well as greater odds of experiencing surgical menopause compared to natural menopause (adjusted odds ratio 1.40, 95% CI 1.18-1.66). Infertility was not associated with the timing of natural or indeterminate menopause. LIMITATIONS, REASONS FOR CAUTION Information on the underlying cause of infertility and related interventions was not collected, which precluded us from disentangling whether associations differed by infertility cause and treatment. Residual confounding is possible given that some covariates were measured at baseline and may not have temporally preceded infertility. WIDER IMPLICATIONS OF THE FINDINGS Women with a history of infertility were more likely to experience early surgical menopause and may therefore benefit from preemptive screening and treatment for gynecologic diseases to reduce bilateral oophorectomy, where clinically appropriate, and its associated health risks in midlife. Moreover, the lack of association between infertility and timing of natural menopause adds to the emerging knowledge that diminishing ovarian reserve does not appear to be a primary biological mechanism of infertility nor its downstream implications for women's health. STUDY FUNDING/COMPETING INTEREST(S) Alberta's Tomorrow Project is only possible due to the commitment of its research participants, its staff and its funders: Alberta Health, Alberta Cancer Foundation, Canadian Partnership Against Cancer and Health Canada, and substantial in-kind funding from Alberta Health Services. The views expressed herein represent the views of the author(s) and not of Alberta's Tomorrow Project or any of its funders. This secondary analysis is funded by Project Grant Priority Funding in Women's Health Research from the Canadian Institutes of Health Research (Grant no. 491439). N.V.S. is supported by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research. H.K.B. is supported by the Canada Research Chairs Program. E.A.B. is supported by an Early Career Investigator Award in Maternal, Reproductive, Child and Youth Health from the Canadian Institutes of Health Research. A.K.S. has received honoraria from Pfizer, Lupin, Bio-Syent, and Eisai and has received grant funding from Pfizer. N.V.S., H.K.B., and E.A.B. have no conflicts of interest to report. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Natalie V Scime
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alison K Shea
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging (MIRA), McMaster University, Hamilton, ON, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
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Cardaillac C, Genest R, Gauthier C, Arendas K, Lemyre M, Laberge P, Abbott J, Maheux-Lacroix S. Preoperative Mechanical Bowel Preparation for Gynecologic Surgeries: A Systematic Review with Meta-analysis. J Minim Invasive Gynecol 2023; 30:695-704. [PMID: 37150431 DOI: 10.1016/j.jmig.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of mechanical bowel preparation (MBP) before benign laparoscopic or vaginal gynecologic surgeries. DATA SOURCES Database searches of MEDLINE (PubMed), Embase (OVID), Cochrane Central Register of Controlled Trials, and Web of Sciences and citations and reference lists published up to December 2021. METHODS OF STUDY SELECTION Randomized clinical trials in any language comparing MBP with no preparation were included. Two reviewers independently screened 925 records and extracted data from 12 selected articles and assessed the risk of bias with the Cochrane risk-of-bias tool for randomized trials tool. A random-effects model was used for the analysis. Surgeon findings (surgical field view, quality of bowel handling and bowel preparation), operative outcomes (blood loss, operative time, length of stay, surgical site infection), and patient's preoperative symptoms and satisfaction were collected. TABULATION, INTEGRATION, AND RESULTS Thirteen studies (1715 patients) assessing oral and rectal preparations before laparoscopic and vaginal gynecologic surgeries were included. No significant differences were observed with or without MBP on surgical field view (primary outcome, risk ratio [RR] 1.01, 95% confidence interval [CI] 0.97-1.05, p = .66, I2 = 0%), bowel handling (RR 1.01, 95% CI 0.95-1.08, p = .78, I2 = 67%), or bowel preparation. In addition, there were no statistically significant differences in perioperative findings. MBP was associated with increased pain (mean difference [MD] 11.62[2.80-20.44], I2 = 76, p = .01), weakness (MD 10.73[0.60-20.87], I2 = 94, p = .04), hunger (MD 17.52 [8.04-27.00], I2 = 83, p = .0003), insomnia (MD 10.13[0.57-19.68], I2 = 82, p = .04), and lower satisfaction (RR 0.68, 95% CI 0.53-0.87, I2 = 76%, p = .002) compared with controls. CONCLUSIONS MBP has not been associated with improved surgical field view, bowel handling, or operative outcome. However, in view of the adverse effects induced, its routine use before benign gynecologic surgeries should be abandoned.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics, Gynecology and Reproductive Medicine (Dr. Cardaillac), Nantes University Hospital, Nantes, France; Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada.
| | - Rosalie Genest
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Caroline Gauthier
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada; Department of obstetrics and gynecology (Dr. Gauthier), CHU Sainte-Justine, Chemin de la Côte Sainte-Catherine, Montréal, Canada
| | - Kristina Arendas
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Madeleine Lemyre
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Philippe Laberge
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
| | - Jason Abbott
- Division of Women's Health (Dr. Abbott), School of Clinical Medicine, UNSW, Sydney, Australia
| | - Sarah Maheux-Lacroix
- Department of Obstetrics and Gynecology (Genest, Drs. Cardaillac, Gauthier, Arendas, Lemyre, Laberge, and Maheux-Lacroix), CHU de Quebec, Québec, QC Canada
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Kroft J, McCaffrey C, Kim E, Jolliffe C, Liu GY, Saskin R, Gatley JM, Ordon M. Surgical Outcomes between Routes of Hysterectomy in Patients with a Previous Cesarean Section. J Minim Invasive Gynecol 2023; 30:319-328.e9. [PMID: 36646311 DOI: 10.1016/j.jmig.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE To determine the difference in surgical complications for patients with a previous cesarean section (CS) undergoing abdominal, vaginal, or laparoscopic hysterectomy. DESIGN A population-based retrospective cohort study. SETTING Province of Ontario, Canada. PATIENTS 10 300 patients with at least 1 CS between July 1, 1991, and February 17, 2018. INTERVENTIONS Benign, nongravid hysterectomy between Apr 1, 2002, and March 31, 2018. MEASUREMENTS AND MAIN RESULTS The primary outcome was a composite of all surgical complications within 30 days of surgery. Secondary outcomes were rate of genitourinary complications, readmission to hospital, and emergency department visit occurring within 30 days of surgery. Of 10 300 patients who had at least one previous CS, who underwent subsequent hysterectomy for a benign indication, 7370 underwent an abdominal hysterectomy (71.55%), 813 (7.9%) had a vaginal hysterectomy, and 2117 (20.55%) underwent a laparoscopic hysterectomy. The adjusted odds of any surgical complication from hysterectomy was significantly lower when performed by the vaginal approach than the laparoscopic approach (odds ratio, 0.32; 95% confidence interval, 0.20-0.51; p <.0001). There was no difference in the odds of surgical complication between abdominal and laparoscopic approaches (odds ratio, 1.09; 95% confidence interval, 0.87-1.37; p = .45). CONCLUSION Our retrospective population-based study demonstrates that, after previous CS, patients selected to undergo vaginal hysterectomy experienced lower risk than either abdominal or laparoscopic approaches. This suggests that CS alone should not be a contraindication to vaginal hysterectomy.
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Affiliation(s)
- Jamie Kroft
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto (Drs. Kroft, McCaffrey, Jolliffe, and Liu).
| | - Carmen McCaffrey
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto (Drs. Kroft, McCaffrey, Jolliffe, and Liu)
| | - Eliane Kim
- Toronto, Ontario, Canada, ICES, Toronto, Ontario, Canada (Kim, Saskin, and Gatley)
| | - Courtney Jolliffe
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto (Drs. Kroft, McCaffrey, Jolliffe, and Liu)
| | - Grace Y Liu
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto (Drs. Kroft, McCaffrey, Jolliffe, and Liu)
| | - Refik Saskin
- Toronto, Ontario, Canada, ICES, Toronto, Ontario, Canada (Kim, Saskin, and Gatley)
| | - Jodi M Gatley
- Toronto, Ontario, Canada, ICES, Toronto, Ontario, Canada (Kim, Saskin, and Gatley)
| | - Michael Ordon
- Department of Surgery, Division of Urology, Unity Health, St. Michael's Hospital (Dr. Ordon), Toronto, Ontario, Canada
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Long AJ, Kaur P, Lukey A, Allaire C, Kwon JS, Talhouk A, Yong PJ, Hanley GE. Reoperation and pain-related outcomes after hysterectomy for endometriosis by oophorectomy status. Am J Obstet Gynecol 2023; 228:57.e1-57.e18. [PMID: 36029832 DOI: 10.1016/j.ajog.2022.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND More research is needed that compares the outcomes between those who underwent a hysterectomy for endometriosis with conservation of one or both ovaries and those who underwent a hysterectomy with bilateral salpingo-oophorectomy. OBJECTIVE This study aimed to compare the rate and types of reoperations (primary outcome) and use of other pain-related health services (secondary outcomes) among people who underwent a hysterectomy with conservation of both ovaries, those who underwent a hysterectomy with unilateral salpingo-oophorectomy, and those who underwent a hysterectomy with bilateral salpingo-oophorectomy. STUDY DESIGN This was a population-based, retrospective cohort study of 4489 patients aged 19 to 50 years in British Columbia, Canada, who underwent a hysterectomy for endometriosis between 2001 and 2016. Index surgeries were classified as hysterectomy alone (conservation of both ovaries), hysterectomy with unilateral salpingo-oophorectomy, or hysterectomy with bilateral salpingo-oophorectomy. Reoperation rate was the primary outcome. Secondary outcomes (measured at 3-12 months and 1-5 years after hysterectomy) included physician visits for endometriosis and pelvic pain, prescriptions filled for opioids, and use of hormonal suppression medications and hormone replacement therapy. RESULTS Reoperation rates were low across all groups, with 89.5% of all patients remaining reoperation free by the end of follow-up (median of 10 years; interquartile range, 6.1-14.3 years). Patients who underwent a hysterectomy alone were more likely to undergo at least 1 reoperation when compared with those who underwent a hysterectomy with bilateral salpingo-oophorectomy (13% vs 5%; P<.0001), most commonly an oophorectomy or adhesiolysis. When oophorectomy as reoperation was removed in a sensitivity analysis, this difference was partially attenuated (6% of hysterectomy alone group vs 3% of hysterectomy with bilateral salpingo-oophorectomy group undergoing at least 1 reoperation). All groups were very similar in terms of rates of physician visits for endometriosis or pelvic pain and the number of days of opioid prescriptions filled. Furthermore, the rate of hormonal suppression medication use was similar among the groups, whereas the rate of prescriptions filled for hormone replacement therapy after hysterectomy with bilateral salpingo-oophorectomy was 60.6% of patients who filled at least 1 prescription at 3 to 12 months after index surgery. CONCLUSION Patients who underwent a hysterectomy with bilateral salpingo-oophorectomy had a lower reoperation rate than those who underwent a hysterectomy with conservation of one or both ovaries. However, there was little difference between the groups for the secondary outcomes measured, including physician visits for endometriosis and pelvic pain, opioid use, and use of hormonal suppression medications, suggesting that persistent pelvic pain after hysterectomy for endometriosis may not differ substantively based on ovarian conservation status. One limitation was the inability to stratify patients by stage of endometriosis or to determine the impact of endometriosis stage or the presence of adnexal disease or deep endometriosis on the outcomes. Moreover, hormone replacement therapy prescriptions was not filled by about 40% of patients after hysterectomy with bilateral salpingo-oophorectomy, which may have significant health consequences for these individuals undergoing premature surgical menopause. Therefore, strong consideration should be given to ovarian conservation at the time of hysterectomy for endometriosis.
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Affiliation(s)
- Alicia J Long
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Paramdeep Kaur
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Lukey
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice S Kwon
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aline Talhouk
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul J Yong
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Gillian E Hanley
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada.
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Horwood G, Singh S. Maximally Invasive Surgery for the Minimally Invasive Gynecologist. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Geneviève Horwood
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Payne M, Bacal V, Nguyen V, Baier K, Gratton SM, Khair S, Medor MC, Mercier S, Choudhry AJ, Chen I. A Validation of Hysterectomy Procedural Codes in the Canadian Institutes for Health Information Discharge Abstract Database. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:353-358. [PMID: 34767982 DOI: 10.1016/j.jogc.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD) is the main source of routinely collected data for gynaecologic surgery in Canada and is increasingly used for research. These data are prone to error as they were originally collected for administrative purposes, and they therefore should be validated for clinical research. The objective of this study was to validate hysterectomy codes from the DAD at a single institution. METHODS This was a retrospective observational study using an existing hospital database. We obtained a consecutive sample of all gynaecologic procedures performed at The Ottawa Hospital from April 2016 to March 2017 using the DAD. Patient data, including diagnosis, procedure type, concomitant procedure, and surgical approach, were reabstracted from records. These data were compared with the DAD Canadian Classification of Health Interventions (CCI) codes using sensitivity, specificity, positive predictive value (PPV), and κ coefficient with associated 95% confidence intervals (CIs). RESULTS Of 1068 gynaecologic procedures, 639 hysterectomies were performed: 39.2% vaginally, 35.4% laparoscopically, and 25.4% abdominally. Median patient age was 46 years (IQR 41-54 y). The κ, sensitivity, specificity, and PPV for all hysterectomies were 0.92 (95% CI 0.90-0.95), 95.1% (95% CI 93.2-96.7), 97.9% (95% CI 96.6-99.3), and 98.5% (95% CI 97.6-99.5), respectively. The κ coefficients for vaginal, laparoscopic, and abdominal hysterectomy were 0.91 (95% CI 0.88-0.94), 0.92 (95% CI 0.89-0.95), and 0.92 (95% CI 0.89-0.95), respectively. Agreement for sub-total hysterectomy and bilateral salpingectomy with oophorectomy was excellent, with κ exceeding 0.80. The level of agreement for salpingectomy alone was poor, though specificity and PPV were high. CONCLUSIONS Our study suggests that hysterectomy-associated CCI codes in CIHI's DAD have a high level of validity for clinical research purposes.
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Affiliation(s)
- Magdalene Payne
- Department of Obstetrics and Gynecology, University of Ottawa, 022-501 Smyth Rd, Ottawa ON, K1H8L6.
| | - Vanessa Bacal
- The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa ON, K1H7W9
| | - Vincent Nguyen
- The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa ON, K1H7W9
| | - Kristina Baier
- The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa ON, K1H7W9
| | | | - Simonne Khair
- The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa ON, K1H7W9
| | | | - Stéphanie Mercier
- The Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa ON, K1H7W9
| | | | - Innie Chen
- Department School of Epidemiology and Public Health, University of Ottawa, 1967 Riverside Drive. Rm 7236-3
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10
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Renaud MC, Sebastianelli A, Grégoire J, Plante M. Five-Year Experience in the Surgical Treatment of Endometrial Cancer: Comparing Laparotomy With Robotic and Minimally Invasive Hysterectomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:21-27. [PMID: 34474173 DOI: 10.1016/j.jogc.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare surgical and oncological outcomes in the treatment of endometrial cancer between laparotomy and minimally invasive surgery. The secondary objective was to determine which MIS approach was the most beneficial. METHODS This was a single-centre retrospective review of all endometrial cancer surgeries performed between November 1, 2012 and October 31, 2017 in a gynaecologic oncology unit of a university hospital. Descriptive statistics were used to compare histopathologic results and oncological outcomes, and Kaplan-Meier estimates were used to compare survival. RESULTS A total of 735 cases were reviewed. The majority of patients (77%) underwent either laparotomy (35%) or robotic-assisted hysterectomy (42%); the remaining patients underwent total laparoscopic hysterectomy (12%) or a laparoscopic-assisted vaginal hysterectomy (8.7%). There was a statistically significant overall survival benefit (P = 0.02), a shorter hospital stay (P < 0.0001), and fewer early surgical complications (<30 d; P = 0.0002), as well as a survival benefit in elderly patients (>70 y) in the robotic-assisted hysterectomy group (P = 0.043) than the laparotomy group. Operating time was shorter in the laparotomy group (P < 0.0001). Recurrence rates in stage 1 low-risk disease were similar between groups. CONCLUSION Minimally invasive surgical approaches, particularly robotic surgery, do not compromise oncologic outcomes, especially for early-stage low-risk disease. In addition, these approaches are associated with fewer early surgical complications and shorter hospital stay, with significantly more same-day discharges. Overall survival and survival in a subgroup of elderly patients were significantly better in the robotic-assisted hysterectomy group.
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Affiliation(s)
- Marie Claude Renaud
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC.
| | - Alexandra Sebastianelli
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC
| | - Jean Grégoire
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC
| | - Marie Plante
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC
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11
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Zakhari A, Papillon-Smith J, Mansour FW, Krishnamurthy S. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy - first experiences at a Canadian academic centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1359-1360. [PMID: 34358707 DOI: 10.1016/j.jogc.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Andrew Zakhari
- McGill University Health Centre - Royal Victoria Hospital, Glen Site, Montreal, QC, Canada.
| | - Jessica Papillon-Smith
- McGill University Health Centre - Royal Victoria Hospital, Glen Site, Montreal, QC, Canada
| | - Fady W Mansour
- McGill University Health Centre - Royal Victoria Hospital, Glen Site, Montreal, QC, Canada
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